Cities throughout the world are increasingly tackling public health issues through policy approaches. However, all too often, the effects of policy and urban planning decisions on the health of some of the most vulnerable residents are overlooked. Health disparities are more common among homeless and unstably housed adults, families, and children due to economic insecurity and the link between housing status and health behaviors. Life expectancy among residents of slum settlements, such as those located in Cairo, is significantly lower than in other urban areas. Only by addressing economic inequities, including housing, can we begin to confront some of the most pressing public health challenges.

Low- and medium-income countries face the largest challenges to providing adequate living situations for all residents. Although homelessness in Egypt is often considered less significant than in other countries, most adequate housing in Egypt (i.e. dwellings with sufficient sanitation and ventilation, access to clean water, and without overcrowding) is out of reach for medium- or low-income families and individuals. In Cairo alone, millions of people reside in precarious housing in slums and squatter settlements (Levinson 2004, Encyclopedia of Homelessness), and millions more live in informal or poorly maintained structures. It is estimated that over 65% of the city’s population resides in informal settlements. Furthermore, there are an estimated one million children living in the street in Egypt, including 50,000 in Cairo. Conditions during the Egyptian revolution may have exacerbated poor housing conditions for some families, as they were evicted and forced into inadequate temporary camps, likely under the guise of unsafe conditions in their former housing.

So how does housing affect people’s health? Housing and health are fundamentally linked. Individuals who are homeless or unstably housed are more vulnerable to infectious diseases, physical violence, and injury. Furthermore, housing represents a fundamental cause, or social condition, that leads to health disparities. Adults and children living on the streets of Egypt, as well as other cities throughout the world, lack access to social and economic resources that promote health. Homeless individuals are more likely than those with adequate housing to engage in unhealthy and risky behaviors as a survival strategy, including alcohol and drug use and risky sexual behaviors (e.g. exchanging sex for money, drugs, or a place to stay). Research has confirmed the high prevalence of risk behaviors and other health risks among children living on the streets of Cairo. Many of these children are at high risk of contracting infectious diseases, especially HIV, and lack the resources to obtain adequate treatment.

Reducing housing problems in low- and middle-income countries like Egypt requires innovative and multifaceted approaches to a range of urban issues. Some NGOs, as well as individuals, are spearheading initiatives to reduce housing shortages in some of the most challenging economic and social conditions. Habitat for Humanity Egypt uses a collaborative construction and financing process similar to that practiced in the United States, but also provides no-cost homes to families who are unable to repay. In addition, Habitat for Humanity uses design innovations in response to local needs. Their vaulted/dome roof design is less costly than traditional construction because it does not rely on steel. It also allows for additions to the roof, a common housing solution among growing families.

Another organization, Ashoka, takes a grassroots approach to a range of social problems, including housing. By empowering social entrepreneurs, termed the “citizen sector,” Ashoka enables individuals to create positive social change throughout the world. For example, Ashoka Fellow SomsookBoonyabancha has addressed slum housing conditions in Thailand by negotiating agreements between squatters and land owners. Owners may develop the street-front portion of property, but in exchange, they must construct dense housing for squatters behind the property. Although this approach may not be appropriate for Cairo, development that incorporates both private interests and the needs of current residents may offer some solutions.

In addition to work being done on health and housing at Ashoka, Cities Alliance has brought together local authorities, national governments, NGOs, and multi-lateral organizations to encourage sustainable development with the goal of urban poverty reduction. By funding City Development Strategy and Slum Upgrading projects throughout the world, Cities Alliance provides resources that allow municipalities to develop and execute urban planning and development strategies that meet social objectives.

Ideas like these have the potential to alleviate some housing shortages in low- and middle-income countries. Although solutions to housing problems may seem distal from the public health issues they also combat, they are essential for creating more equitable and healthier communities. Housing initiatives must also target the most vulnerable individuals with existing health conditions, such as HIV, or those at high risk. This might be accomplished by providing designated developments or apartments.

Health service organizations working in Egypt and other low- and middle-income countries must begin to address fundamental, or upstream, causes of health disparities, and recognize and advocating for housing as a form of treatment and prevention. Specifically, transformations in Egypt’s and Cairo’s governmental and policy environment create an opportunity to address health through urban development decisions. Only by taking a holistic and multidisciplinary approach to developing cities can we begin to create healthier and more equitable communities.

Anne Bozack, MPH is a Project Director in the Center for Evaluation and Applied Research at the New York Academy of Medicine (NYAM). She is currently working on health disparities and prevention of chronic disease in urban populations. Prior to joining NYAM, Anne gained research experience at Columbia University focusing on homelessness, prisoner reentry, and HIV/AIDS and earned her MPH while there.

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